287.485 Subsidy for retired officer or
employee: Report required to obtain subsidy; audit of service credit required;
billing; commencement of payment; adjustment of amount of subsidy; assumption
of liability for service credit earned.

287.490 Subsidy for retired officer or
employee: Calculation of amount of payment.

287.730 Appointment of subcommittee to
review proposals for position of recordkeeper and make recommendations; general
meeting of Committee regarding applicants; negotiation of changes to accepted
proposals.

NAC 287.005Definitions. (NRS 287.043)As used
in NAC 287.005 to 287.695,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 287.0056 to 287.145,
inclusive, have the meanings ascribed to them in those sections.

NAC 287.0056“Biennial employee” defined. (NRS 287.043)“Biennial
employee” means an employee whose position of employment is only authorized for
4 to 6 months every other year and who plans to return to the same or a similar
position for the next period during which such a position is authorized.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R126-00, 12-22-2000, eff. 1-1-2001; A by R109-12, 12-20-2012)

NAC 287.059“Initial date of hire” defined. (NRS 287.043)“Initial
date of hire” means the first date on which service credit is earned by a
participant during the participant’s last period of continuous employment with
a public employer, as determined by the appropriate certifying agency.

(Added to NAC by Com. on Benefits, eff. 5-4-92)—(Substituted
in revision for NAC 287.0075)

NAC 287.085“Open enrollment” defined. (NRS 287.043)“Open
enrollment” means the event in which participants in the Program may change
elections offered by the Program concerning coverage and dependents.

NAC 287.090“Opt-out plan” defined. (NRS 287.043)“Opt-out
plan” means an alternative plan to provide life, accident or health insurance,
or any combination thereof, for a group which is approved by the Board pursuant
to NRS 287.0479.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

NAC 287.095“Participant” defined. (NRS 287.043)“Participant”
includes the following persons who are eligible to participate in the Program:

1. An officer or employee of a participating
public agency;

2. A retired officer or employee whose last
employer is a participating public agency;

3. A retired officer or employee whose last
employer is not a participating public agency who has been covered continuously
by the Program as a retiree since November 30, 2008;

4. A surviving dependent of a deceased
officer or employee of a participating public agency who was covered by the
Program at the time of death of the deceased officer or employee if the
deceased officer or employee had 10 years or more of service credit, as
determined by the appropriate certifying agency, and is deemed to be retired
pursuant to NRS 286.676;

5. A surviving dependent of a deceased
retired officer or employee described in subsection 2 or 3 if the dependent was
covered by the Program at the time of death of the retired officer or employee;

6. A surviving spouse of a deceased retired
public officer or employee who chooses to reinstate insurance pursuant to NRS 287.0475;

7. A surviving spouse of a police officer,
firefighter or official member of a volunteer fire department who was killed in
the line of duty;

8. A surviving child of a police officer,
firefighter or official member of a volunteer fire department who was killed in
the line of duty;

9. A biennial employee;

10. A Legislator whose term of office has
not expired; and

11. A person who has elected to continue
coverage pursuant to the Public Health Service Act, 42 U.S.C. § 300bb-1(a).

NAC 287.135“Retired officer or employee” defined. (NRS 287.043)“Retired
officer or employee” means an officer or employee of a public employer who:

1. Has met the requirements to receive, and
is receiving any distribution of, benefits from:

(a) The Judges’ Retirement System;

(b) The Public Employees’ Retirement System (PERS);

(c) The Legislators’ Retirement System;

(d) A retirement program for professional employees
offered by or through the Nevada System of Higher Education, including, without
limitation, a retirement plan alternative provided pursuant to NRS 286.802, a tax sheltered
annuity or a deferred compensation plan; or

(e) A long-term disability plan of the public
employer; and

2. Has a total of at least 5 years of
full-time service credit from all his or her public employers as determined by
the appropriate certifying agency, excluding any service credit purchased
pursuant to NRS 1A.310, 218C.370 or 286.300.

NAC 287.145“Vendor” defined. (NRS 287.043)“Vendor”
means a person who provides products or services to the Program or its
participants and dependents, including, but not limited to, an insurance
broker, a consultant, an insurer, a health maintenance organization, a physical
or mental health care provider, a case management or utilization management
company, a dental or vision care provider, a hospital, a medical facility, a
certified public accountant, an actuary, an attorney specializing in health
care, a health care auditor, a health educator, a pharmacy or pharmacy benefit
manager and a preferred provider organization. The term does not include an
opt-out plan.

NAC 287.150“Full-time employment” interpreted. (NRS 287.043, 287.045)As used
in NRS 287.045, the Board
interprets “full-time employment” to mean the employment, election or
appointment by a participating public agency of a person who:

1. In any calendar month, works as a public
employee or officer at least 80 hours. The Board will consider such full-time
employment to commence at the beginning of the month in which the public
employee or officer works 80 hours.

2. Is elected or appointed as a public
officer who receives any compensation regardless of the number of hours worked.
The Board will consider such full-time employment to commence at the beginning
of the month in which the person’s term of service or term of office begins.

NAC 287.155Date of receipt of required notices. (NRS 287.043)A person
shall be deemed to have received any notice required pursuant to this chapter
or chapter 287 of NRS 5 days after the
notice is mailed, by first-class mail, to that person’s last known address,
unless the Executive Officer or an authorized designee thereof waives this
provision because of extenuating circumstances that are sufficient to justify
the waiver.

NAC 287.160Determination of late submission of documents or information. (NRS 287.043)Any
form, application, claim or other document or information that is required to
be submitted to the Program, Executive Officer or Board on or before a specific
date will be considered late if the form, application, claim or other document
or information is not:

1. Received by the Program, Executive
Director or Board, as applicable, before 5 p.m. on that date; or

2. Any member of the Board may submit to the
Executive Officer, or in his or her absence, the Operations Officer of the
Program appointed pursuant to NRS
287.0426, a request for a matter to be placed on the agenda of a meeting of
the Board.

1. The minutes of each meeting of the Board
must be distributed to each member of the Board.

2. A transcript of a meeting posted to the
Internet website of the Board pursuant to NRS 287.0415 will remain posted on
the Internet website of the Board for at least 6 months after posting. During
the period in which the transcript of the meeting is posted on the Internet
website of the Board, a person may request a hard copy of the transcript.

3. The Board may charge the person a fee for
the transcript that does not exceed the actual cost of the Board to provide the
copy of the transcript.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R089-05, eff. 6-28-2006; A by R109-12, 12-20-2012)

1. Except as otherwise provided in
subsection 3, a person may request that the Executive Officer issue an advisory
opinion concerning the applicability of any provision of NRS 287.0402 to 287.049, inclusive, that pertains
to the jurisdiction of the Board or any regulation adopted by the Board
pursuant thereto. Any request for an advisory opinion concerning the
applicability of any provision of NRS
287.0402 to 287.049,
inclusive, that pertains to the jurisdiction of a public agency or public
officer other than the Board or any regulation adopted by the public agency or
public officer must be submitted to that public agency or public officer.

2. A request for an advisory opinion
pursuant to subsection 1 must be in writing and set forth:

(a) The name and address of the person requesting
the advisory opinion;

(b) A clear and concise statement of the specific
question for which the advisory opinion is being sought; and

(c) A statement of the facts that support the
advisory opinion being sought.

3. A person may not request an advisory
opinion concerning a question or matter that is an issue in a review or an
appeal of a claim or in a pending administrative, civil or criminal proceeding
in which the person is a party or otherwise involved.

4. The Executive Officer shall review a
request for an advisory opinion and issue a response within 30 days after
receiving the request.

5. An advisory opinion issued by the
Executive Officer must be limited to the facts and circumstances set forth in
the request.

6. An advisory opinion issued by the
Executive Officer is appealable to the Board in the same manner as any other
appealable decision.

NAC 287.192Advisory opinions: Oral opinion prohibited; effect of response by
electronic mail or oral response. (NRS 233B.120, 287.043)The
Executive Officer shall not render an oral advisory opinion to a request for an
advisory opinion. A response by electronic mail or an oral response, including,
without limitation, a response given over the telephone, to a request for an
advisory opinion that is given by the Executive Officer, a member of the Board
or staff of the Board are not decisions or official advisory opinions pursuant
to this section.

1. Except as otherwise provided in
subsection 3, a person may file a petition with the Executive Officer
requesting that the Board issue a declaratory order concerning the
applicability of any provision of NRS
287.0402 to 287.049,
inclusive, that pertains to the jurisdiction of the Board or any regulation
adopted by the Board pursuant thereto. Any petition for a declaratory order
concerning the jurisdiction of a public agency or public officer other than the
Board or any regulation adopted by the public agency or public officer must be
submitted to that public agency or public officer.

2. A petition for a declaratory order filed
pursuant to subsection 1 must include, without limitation:

(a) The name and address of the petitioner;

(b) The reason for requesting the declaratory
order;

(c) A statement of the facts that support the
petition for a declaratory order; and

(d) A clear and concise statement of the question
or matter to be decided by the Board.

3. A person may not file a petition for a
declaratory order concerning a question or matter that is an issue in a review
or an appeal of a claim or in a pending administrative, civil or criminal
proceeding in which the person is a party or otherwise involved.

4. The Executive Officer shall notify the
Chair of the petition for a declaratory order not later than 10 days after the
petition is received by the Executive Officer.

5. The Board may:

(a) Conduct a hearing to determine issues of fact
or to hear arguments relating to a petition for a declaratory order and may
enter reasonable orders that govern the conduct of the hearing.

(b) Request that the petitioner provide additional
information or arguments relating to the petition.

(c) Issue a declaratory order based on the contents
of the petition and any material submitted with the petition.

(d) Consider relevant actions that have been issued
by the Board or any other entity which apply or interpret the statute or regulation
in question.

(e) Consider any other information that the Board
determines is relevant to the question or matter to be decided by the Board.

6. The Board will notify the petitioner in
writing within 10 days after any action taken by the Board concerning the
petition.

1. Any person who wishes to petition for the
adoption, filing, amendment or repeal of a regulation that the Board is
authorized to adopt, file, amend or repeal must file a petition with the
Executive Officer.

2. A petition for the adoption, filing,
amendment or repeal of a regulation must include, without limitation:

(a) The name and address of the petitioner;

(b) A clear and concise statement, including, if
applicable, the proposed language, of the regulation to be adopted, filed,
amended or repealed;

(c) The reason for petitioning for the adoption,
filing, amendment or repeal of the regulation; and

(d) The statutory authority for the adoption,
filing, amendment or repeal of the regulation.

3. The Executive Officer may refuse to act
upon a petition for the adoption, filing, amendment or repeal of a regulation
if the petition does not contain the information required by subsection 2.

4. The Executive Officer shall notify the
petitioner in writing of his or her decision with regard to the petition within
30 days after the petition is filed.

NAC 287.310Prerequisites to participation; fees; establishment of rates;
provision to agency of report on history of claims. (NRS 287.043)

1. To participate in group coverage or
insurance provided by the Program, a local governmental agency, through its
governing body, must provide to the Program:

(a) A nonrefundable application fee of $250, plus
$2.25 per participant for any application involving 100 or more participants.

(b) A nonrefundable fee to be deposited in the Fund
for the Public Employees’ Benefits Program created pursuant to NRS 287.0435 for the purpose of
funding the reserve maintained by the Program to stabilize rates. The Executive
Officer or a designee thereof shall calculate the amount of the nonrefundable
fee by:

(1) Dividing the funded reserve maintained by
the Program to stabilize rates on the date on which the local governmental
agency submitted its application to participate in the Program by the total
number of participants in the Program on that date; and

(2) Multiplying the number determined pursuant
to subparagraph (1) by the total number of officers and employees of the local
governmental agency who enroll in the Program on the effective date of
participation by the local governmental agency in the Program.

Ê The fee, or
if installment payments are authorized by the Program, the first installment
payment of the fee, must be paid by the effective date of participation by the
local governmental agency in the Program.

(c) If the local governmental agency has 100 or
more participants, information, as determined by the actuary of the Program,
sufficient to make an actuarial determination as to the appropriate rates for
the local governmental agency, including, without limitation, the 3 most recent
years of claims history data of the local governmental agency, if any exists,
in an electronic format that is compatible with the actuarial services of the
Program.

(d) The residential zip code, gender, age and
current selection for coverage of:

(1) The eligible members, regardless of
current enrollment, of the local governmental agency; and

(2) Those members that are currently enrolled
in the group plan of the local governmental agency and their respective number
of enrolled dependents.

(e) An interlocal contract executed pursuant to NRS 287.043, on a form provided by
the Program. Effective November 30, 2008, such an interlocal contract must
include a provision that requires the local governmental agency to participate
in the Program for at least 4 years before the local governmental agency may
withdraw from the Program in accordance with NAC
287.320.

(f) A statement that all terminal fees and costs
associated with the previous health plan will be paid by that local
governmental agency group.

2. The actuary for, and the members of the
staff of, the Board shall review the request and establish the initial rates
for the requesting local governmental agency as follows:

(a) For a local governmental agency with less than
100 participants, the requesting local governmental agency will not be rated
separately from those same or similar participating local governmental
agencies.

(b) For a local governmental agency with 100 or
more participants:

(1) If, upon review of the claims experience
of participating local governmental agency groups or the past claims history of
the requesting local governmental agency, the actuary for the Board determines
the experience for the requesting local governmental agency does not exceed 105
percent of the appropriate rate for the same or similar participating local
governmental agency groups, the requesting local governmental agency will not
be rated separately from those same or similar participating local governmental
agency groups.

(2) If the claims experience for the
requesting local governmental agency exceeds 105 percent of the appropriate
rate for the same or similar participating local governmental agency groups,
the actuary for the Program and a member of the staff will submit a written
report, with recommended rates, to the Board. The recommended rates must equal
the difference of the premium or contribution for participating local
governmental agency groups and the cost of the experience of the requesting
local governmental agency.

(3) If the requesting local governmental
agency has no claims experience, the rates will be equal to 105 percent of the
standard rate for a participating local governmental agency that has no
separate rating applied.

Ê Rates
established pursuant to subparagraphs (2) and (3) apply until the end of the
plan year immediately following the year in which the rates were established,
at which time the actuary for, and the members of the staff of, the Board shall
review the claims experience of the requesting local governmental group to
determine an appropriate rate or whether the standard rate should be applied.

3. For a participating local governmental
agency, the Executive Officer or the designee shall provide, upon written
request from the participating local governmental agency, the history of claims
for that participating local governmental agency. The Executive Officer or the
designee shall charge for each report the actual cost of providing the report.
The report must include:

(a) A summary of the medical, prescription and
dental claims paid by the self-funded plan for each month covered by the
report; and

(b) A summary of the monthly premiums or
contributions paid during the period covered by the report.

Ê The Executive
Officer or the designee shall provide the report within 90 days after receipt
of the request.

(Added to NAC by Com. on Group Ins., eff. 5-27-86; A by
Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by R126-00,
12-22-2000, eff. 1-1-2001; R154-03, 3-22-2004; R126-07, 1-30-2008; R017-08, 6-17-2008)

1. Except as otherwise provided in
subsection 2 of NRS 287.045,
every state officer or employee is eligible to participate in the Program on
the first day of the month following the completion of 60 days of full-time
employment.

2. Every officer or employee who is employed
by a participating local governmental agency on a permanent and full-time basis
on the date on which the participating local governmental agency enters into an
agreement to participate in the Program pursuant to paragraph (a) of subsection
1 of NRS 287.025, and every
officer or employee who commences employment with that participating local
governmental agency after that date, is eligible to participate in the Program
on the first day of the month following the completion of 60 days of full-time
employment, unless that officer or employee is excluded pursuant to
sub-subparagraph (III) of subparagraph (2) of paragraph (h) of subsection 2 of NRS 287.043.

3. Every member of the Senate and Assembly
is eligible to participate in the Program on the first day of the month
following the 60th day after the member’s initial term of office begins.

1. Except as otherwise provided in NAC 287.312, a participant who desires or is required
to enroll or disenroll a person in the Program as a dependent as a result of a
life event that qualifies the participant to amend his or her coverage outside
the period of open enrollment must, within 60 days after the date on which the
dependent becomes eligible to participate or loses his or her eligibility to
participate in the Program:

(a) Execute a declaration of enrollment
electronically through the Internet website of the Board or by submitting a
form prescribed by the Program pursuant to NAC 287.318,
under penalty of perjury and subject to the provisions of NRS 686A.290 and 686A.291.

(b) Submit copies of any supporting documentation
required to establish or terminate the dependent’s eligibility to participate
in the Program as a dependent as requested by the Program.

2. Except as otherwise provided in
subsections 3 and 4, if a participant fails to enroll or disenroll a person in
the Program as a dependent within 60 days after the date on which the dependent
becomes eligible to participate or loses his or her eligibility to participate
in the Program, the participant may not enroll or disenroll the person in the
Program as a dependent until the next period of open enrollment.

3. The Program will enroll a person as a
dependent of a participant in accordance with an order to obtain health
insurance for his or her child pursuant to NRS 31A.350.

4. The Program will disenroll a person as a
dependent of a participant on the date on which the dependent becomes deceased.

1. To determine whether the child of a
participant or of his or her spouse or domestic partner who is incapable of
self-support because of a physical or mental disability continues to be
eligible for coverage by the Program, the Executive Officer or his or her designee:

(a) Shall require submission by a physician who
provides care to the child of a written statement on a form prescribed by the
Board indicating that the child has a mental or physical impairment which
causes the child to be incapable of self-sustaining employment and to depend on
the participant or his or her spouse or domestic partner primarily for support.
The written statement required by this paragraph must be prepared by the
physician within 90 days before the statement is provided to the Program.

(b) May require:

(1) Submission of periodic updates regarding
the physical or mental disability of the child by the participant or his or her
spouse or domestic partner;

(2) Submission of the child to a mental or
physical examination conducted by a physician selected by and at the expense of
the Program; and

(3) Any other documentation required by the
Program that demonstrates financial support of the child by the participant or
his or her spouse or domestic partner.

2. Persons who are eligible for coverage as
a dependent may include:

(a) Biological children;

(b) Adopted children;

(c) Children placed in the residence of the
participant for adoption;

(d) Stepchildren; and

(e) Any other person who:

(1) Bears a relationship described in 26
U.S.C. § 152(c)(2) to the participant or his or her spouse or domestic partner;

(2) Is unmarried;

(3) Has not attained the age set forth in 45
C.F.R. § 147.120(a);

(4) Either resides with the participant or is
enrolled in a program of secondary education or an independently accredited
program of postsecondary education, including, without limitation, a college,
university, community or junior college, graduate school or accredited trade or
business school, on a full-time basis;

(5) Satisfies one of the following conditions:

(I) Is currently under a permanent legal
guardianship of the participant or his or her spouse or domestic partner
pursuant to chapter 159 of NRS; or

(II) Was eligible to be claimed as a
dependent on the federal income tax return of the participant or his or her
spouse or domestic partner for the immediately preceding calendar year; and

(6) Is in a relationship with the participant
or his or her spouse or domestic partner that is similar to a child-parent
relationship. The participant or his or her spouse or domestic partner must
complete and submit to the Program an affidavit attesting to the fact of the
relationship.

3. A foster child of a participant or his or
her spouse or domestic partner is not eligible for coverage as a dependent.

NAC 287.3125Dependents: Terms and conditions of certain changes. (NRS 287.043)Except
during a period of open enrollment, the right to change coverage or insurance
for a dependent or to add or change dependents is governed by the terms and
conditions of any applicable plan, insurance policy or law.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R089-05, eff. 6-28-2006; A by R016-08, 8-26-2008, eff. 7-1-2009)

NAC 287.314Provision of information about Program to participants,
representatives of participating public agencies and employees of Program. (NRS 287.043)

1. The Executive Officer or a designee
thereof shall provide information about the Program to participants,
representatives of participating public agencies and employees of the Program.

2. The information required to be provided
pursuant to subsection 1 must include, without limitation:

(a) Procedures, forms and instructions relating to
enrollment and participation in the Program;

(b) Forms and instructions relating to enrollment
through the Internet website of the Program; and

(c) A summary of the benefits available through the
Program.

3. The Executive Officer or a designee
thereof shall make the information about the Program described in subsection 2
available on:

(a) An Internet website established and maintained
by the Program for participants and representatives of participating public agencies;
and

(b) An Intranet site relating to the internal
management of the Program for employees of the Program.

4. A notice that explains how to access the
information on the Internet website of the Program and how to request a written
copy of the information required to be provided pursuant to subsection 2 must
be provided electronically or by first-class mail, to the last electronic mail
or mailing address provided by a participant, to:

(a) A new participant within 7 days after the
Program is notified of the employment of the participant with a participating
public agency; and

(b) All participants annually, at least 75 days
before the first day of the following plan year.

NAC 287.317Participating public agency to notify Program of appointment of
persons eligible to participate in Program or of termination of appointment;
enrollment. (NRS
287.043)

1. A participating public agency shall
notify the Program in a format prescribed by the Program upon:

(a) Appointing to the participating public agency a
person who will be eligible to participate in the Program pursuant to NRS 287.045, so the Program may
provide the required information about the Program to the employee pursuant to NAC 287.314; or

(b) The termination of an appointment to the
participating public agency,

Ê within 15
days after the employee’s first or last day of employment with the
participating public agency, as applicable.

2. The employee shall enroll in the Program:

(a) Electronically through the Internet website of
the Board; or

(b) By submitting the completed enrollment forms to
the Program,

Ê and
submitting any supporting documents to the Program.

3. If the employee fails to enroll in the
Program pursuant to subsection 2 before the first day of eligibility for
coverage of the employee or 30 days after the first day of employment of the
employee with the participating public agency, whichever occurs later, the
employee only will be enrolled in the base plan.

4. As used in this section, “base plan”
means the plan designated by the Board as the default plan for the plan year,
as described in the plan documents.

NAC 287.318Enrollment forms: Required information. (NRS 287.043)Enrollment
forms that are submitted to the Program must include, without limitation:

1. The name, address, social security
number, if any, and signature of the person who is enrolling in the Program;
and

2. The name and social security number, if
any, of any dependent that the person chooses to cover under the Program.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R089-05, eff. 6-28-2006; A by R109-12, 12-20-2012)

NAC 287.319Notification of change of address by participant to Program. (NRS 287.043)A
participant shall notify the Program within 30 days after a change of address
of the participant.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R089-05, eff. 6-28-2006; A by R107-09, 4-20-2010)

NAC 287.320Withdrawal from Program: Procedure; termination of coverage;
limitation on reentry; eligibility of certain officers and employees after
exclusion of group; liability of Program. (NRS 287.043)

1. A participating local governmental agency
which intends to terminate its interlocal contract and withdraw from the
Program must give a written notice to the Executive Officer of the Program at
least 60 days before the date on which it intends to withdraw. The effective
date of withdrawal is the last day of the month in which the 60-day period
expires.

2. Effective November 30, 2008, if a
participating local governmental agency withdraws from the Program:

(a) Coverage provided for all active officers and
employees of the local governmental agency terminates on the date on which the
local governmental agency withdraws from the Program.

(b) Except for retired officers and employees who
were enrolled in the Program on November 30, 2008, and continue their
participation in the Program, coverage provided for all retired officers and
employees of the local governmental agency terminates on the date on which the
local governmental agency withdraws from the Program. If a retired officer or
employee whose coverage by the Program terminates pursuant to this paragraph
qualifies as a dependent of a participant, the termination of coverage pursuant
to this paragraph is a qualifying status change for the retired officer or
employee.

3. Unless waived by the Board, a
participating local governmental agency that withdraws from the Program may not
reenter the Program for 3 years after the date on which it withdraws.

4. If a group of officers and employees of a
participating local governmental agency who are eligible for health coverage
from a health and welfare plan or trust that arose out of collective bargaining
under chapter 288 of NRS or a trust
established pursuant to 29 U.S.C. § 186 is excluded from participation in the
Program on or after November 30, 2008:

(a) Except for retired officers and employees who
were enrolled in the Program on November 30, 2008, and continue their
participation in the Program, all retired officers and employees who were
members of the group will be excluded from participation in the Program;

(b) Active officers and employees in the group are
not eligible to participate in the Program after retirement; and

(c) All active and retired officers and employees
of the local governmental agency that are not members of the group are eligible
to continue their participation in the Program until the date on which the
participating local governmental agency terminates its participation in the
Program.

5. Except for retired officers and employees
who were enrolled in the Program on November 30, 2008, and continue their
participation in the Program, the Program is not liable for any expenses or
claims of an officer or employee or retired officer or employee, or any
dependents thereof, of the withdrawing local governmental agency or excluded
group incurred after the effective date of the withdrawal of the local
governmental agency or exclusion of the group from the Program.

(Added to NAC by Com. on Group Ins., eff. 5-27-86; A by
Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by R126-00,
12-22-2000, eff. 1-1-2001; R154-03, 3-22-2004; R126-07, 1-30-2008; R108-12, 12-20-2012)

NAC 287.357Application to leave Program: Contents. (NRS 287.043, 287.0479)An
application to leave the Program must include, without limitation:

1. A copy of the plan of benefits to be
offered under the proposed opt-out plan, including, without limitation, a
description of:

(a) The benefits to be provided under the proposed
opt-out plan;

(b) The manner for determining eligibility for
benefits under the proposed opt-out plan; and

(c) The circumstances under which any participant
in the proposed opt-out plan, including, without limitation, active and retired
officers and employees, may lose coverage under the proposed opt-out plan.

2. A description of the manner in which
initial eligibility for benefits under the proposed opt-out plan will be
determined, including, without limitation, whether members of the group will
experience any gap in coverage during the period between when the group leaves
the Program and coverage is available for the group under the proposed opt-out
plan.

3. The proposed effective date of the
departure of the group from the Program, which must coincide with the start
date of a plan year.

4. The name of the group.

5. A list of the proposed participants in
the proposed opt-out plan, including, without limitation, the name, social
security number and date of birth of each proposed participant.

6. The federal tax identification number of
the proposed opt-out plan.

7. A copy of the contract pursuant to which
the members of the group will receive coverage from the proposed opt-out plan.
The contract must include, without limitation, the amount of premiums or
contributions that will be required to maintain coverage for the members of the
group under the proposed opt-out plan.

8. Evidence establishing that the proposed
opt-out plan is or will be operated pursuant to such sound accounting and
financial management practices as to ensure that the group will continue to
receive adequate benefits. Such evidence must include, without limitation:

(a) Financial statements;

(b) Audits of financial statements of the proposed
opt-out plan, if any, for the 2 years immediately preceding the date of
application, which must reflect unqualified opinions by the persons who
performed the audits of the financial statements concerning the financial
soundness of the proposed opt-out plan; and

(c) Any other information requested by the Board or
determined by the group to be relevant to the evaluation of the:

(1) Financial management practices of the
proposed opt-out plan; or

(2) Financial soundness of the proposed
opt-out plan.

9. A completed Business Associate Agreement
that is consistent with the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, as amended, and is in a form
acceptable to the Board, or a certification that the opt-out plan is a covered
entity under and complies with all federal privacy regulations.

10. If the proposed opt-out plan is secured
from an insurer, a copy of the current certificate of authority issued by the
Commissioner of Insurance to the insurer which indicates that the insurer is
authorized to provide the coverage proposed to be offered under the proposed
opt-out plan in this State.

11. The name and contact information of a
representative of the group who will be available to answer questions from the
Board concerning the application.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R089-05, 6-28-2006; R002-12, 6-29-2012)

1. To apply to leave the Program, a group
must submit an application to the Board on or before the first day of the 10th
month before the proposed effective date of the departure of the group from the
Program.

2. If additional information is required to
process any application, the Board will notify the representative of the group
who is designated pursuant to NAC 287.357.

3. The Board will provide an opportunity
for:

(a) A representative of the Program to present
arguments for or against the approval of an application.

(b) The representative of the group who is
designated pursuant to NAC 287.357 to present
arguments that support the approval of an application.

4. The Board will approve or deny each
application received pursuant to subsection 1 not later than the 15th day of
the sixth month before the proposed effective date of the departure of the
group from the Program.

5. The Board will notify each applicant of
the date and time of the meeting during which the Board will render a decision
on the application of the applicant.

(3) The proposed opt-out plan provides
adequate benefits at the time of application that includes offering the same
coverage to active officers and employees and retired officers and employees
using rates based on the commingled experience of all active and retired
participants; and

(4) The group applying to leave the Program,
and the members thereof, meet the requirements set forth in subsection 3 of NRS 287.0479.

(b) May consider:

(1) Whether the cumulative impact of a group
leaving the Program on the costs of premiums or contributions for the remaining
participants in the Program is so detrimental as to cause a significant
negative impact on the Program;

(2) Whether the current financial condition of
the Program is such that the departure of the group would constitute a
significant negative impact on the Program;

(3) Whether the departure of the group is
administratively feasible;

(4) Whether independent, actuarial or other
reviews obtained by the Board indicate that the departure of the group will
cause a significant negative impact on the Program; and

(5) Any other information that the Board deems
relevant.

2. Findings by the Board concerning the
considerations described in subsection 1 must be based exclusively on
substantial evidence.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R089-05, 6-28-2006; R002-12, 6-29-2012)

NAC 287.363Approval of application by Board: Format and contents of
decision; responsibilities of and noncompliance by group. (NRS 287.043, 287.0479)

1. A decision of the Board to approve an
application to leave the Program will be in writing and will include, without
limitation, the effective date of departure of the group from the Program and
the dates for completion of any administrative tasks necessary to effect the
departure of the group.

2. If the Board approves the application of
a group to leave the Program, the approval will be conditioned upon completion
of the following actions:

(a) The group must submit to the Board a completed
release and waiver of rights agreement, in a form acceptable to the Board,
obtained from and signed by each member of the group.

(b) A contract, in a form acceptable to the Board,
must be executed between the Program and the proposed opt-out plan of the
group. The contract must set forth the terms of coverage for the group,
provisions for the payment of premiums or contributions of participants to the
opt-out plan and such other details necessary to effect departure of the group
from the Program.

3. On or before the 25th day of the fourth
month before the effective date of the departure of the group from the Program
established pursuant to NAC 287.369:

(a) The completed release and waiver of rights
agreement must be submitted to the Board; and

(b) The contract between the Program and the
proposed opt-out plan of the group must be executed between the Program and the
proposed opt-out plan of the group.

4. If a group whose application to leave the
Program has been approved by the Board fails to comply with the requirements of
this section or any provision of the decision of the Board to approve the
application of the group, the Board may declare the contract between the
Program and the opt-out plan of the group void.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R023-09, 11-25-2009; R002-12, 6-29-2012)

NAC 287.365Denial of application by Board: Format and contents of decision. (NRS 287.043, 287.0479)A
decision of the Board to deny an application of a group to leave the Program
will be in writing and will include, without limitation:

1. The reasons of the Board for denying the
application.

2. The findings of the Board on the
mandatory criteria for review set forth in paragraph (a) of subsection 1 of NAC 287.361.

3. The findings of the Board on any of the
optional criteria for review set forth in paragraph (b) of subsection 1 of NAC 287.361 that the Board considered in reaching its
decision.

4. A statement that any data, information or
report on which the Board relied to make its decision to deny the application
is available to the group upon request.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R089-05, 6-28-2006)

NAC 287.367Denial of application by Board: Procedure for reconsideration. (NRS 287.043, 287.0479)A group
whose application to leave the Program has been denied by the Board may file a
request for reconsideration with the Board not later than 40 days after the
denial. The request may include any additional information that the group
determines is relevant to reconsideration. The Board will hold a
reconsideration hearing and render its decision within 30 days after receiving
the request.

1. A group whose request for reconsideration
with the Board has been denied pursuant to NAC 287.367
may file an appeal with the Hearings Division of the Department of
Administration.

2. On the same date on which a group files
an appeal with the Hearings Division pursuant to subsection 1, the group must
provide a copy of the appeal to the Executive Officer. Within 30 days after the
Executive Officer receives a copy of the appeal, the Executive Officer shall
transmit to the Hearings Division a copy of:

(a) The decision of the Board to deny the
application of a group to leave the Program that was prepared pursuant to NAC 287.365; and

3. A hearing officer of the Hearings
Division shall review the decision of the Board. Review of the decision of the
Board is confined to the information provided to the Hearings Division pursuant
to subsection 2, except that in cases concerning alleged irregularities in
procedure before the Board that are not shown in the decision or the record,
the hearing officer may receive evidence concerning the irregularities.

4. The burden of proof is on the group to
show that the decision of the Board to deny the application of the group is
invalid pursuant to subsection 6.

5. The hearing officer shall not substitute
his or her judgment for that of the Board as to any criteria, data, information
or report on which the Board relied to make its decision to:

(a) Deny the application of the group to leave the
Program; or

(b) Deny the request for reconsideration of the
application of the group to leave the Program.

6. The hearing officer may remand or affirm
the decision of the Board to deny the application of the group to leave the
Program or set it aside in whole or in part if the decision of the Board is:

(a) In violation of constitutional or statutory
provisions;

(b) In excess of the statutory authority of the
Board;

(c) Made upon unlawful procedure;

(d) Affected by other error of law;

(e) Clearly erroneous in view of the reliable,
probative and substantial evidence in the information provided to the Hearings
Division pursuant to subsection 2; or

(f) Arbitrary or capricious or characterized by
abuse of discretion.

7. The decision of the hearing officer made
pursuant to subsection 6 is final and not subject to judicial review.

NAC 287.369Effective date of departure from Program; coverage by Program
until departure. (NRS 287.043, 287.0479)

1. The effective date of departure from the
Program of a group whose application has been approved by the Board pursuant to
NRS 287.0479 is the first day
of the plan year that is at least 120 days after the date on which the Board
approves the application.

2. The Program shall provide coverage to
participants in a group that has been approved by the Board to leave the
Program until the effective date of departure of the group from the Program set
forth in the decision of the Board approving the application of the group to
leave the Program.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

1. If an officer or employee is eligible to
join an opt-out plan at the commencement of his or her employment, the officer
or employee must, upon commencing employment:

(a) Elect to join the opt-out plan; or

(b) Decline coverage under the opt-out plan.

2. If an officer or employee becomes
eligible to join an opt-out plan after the commencement of his or her
employment, the officer or employee must, at the time of his or her
eligibility:

(a) Elect to join the opt-out plan; or

(b) Decline coverage under the opt-out plan.

Ê If the
officer or employee is a member of the Program at the time he or she becomes
eligible to join the opt-out plan, the officer or employee shall terminate
coverage by the Program.

3. Except as otherwise provided in
subsection 4, if an officer or employee in an opt-out plan becomes ineligible
to continue participation in the opt-out plan, the officer or employee must
terminate coverage by the opt-out plan and:

(a) If the officer or employee is eligible to join
a different opt-out plan:

(1) Elect to join the other opt-out plan,
subject to the requirements for enrollment in the opt-out plan; or

(2) Decline coverage under the other opt-out
plan.

(b) If the officer or employee is eligible to join
the Program:

(1) Elect to join the Program, subject to the
requirements for enrollment of the Program; or

(2) Decline coverage under the Program.

4. If an officer or employee in an opt-out
plan becomes ineligible to continue participation in the opt-out plan because
he or she is no longer employed by a participating public agency, the officer
or employee may elect to continue coverage under the opt-out plan pursuant to
the Public Health Service Act, 42 U.S.C. § 300bb-1 et seq. or the Consolidated
Omnibus Budget Reconciliation Act, Public Law 99-272, as applicable.

5. It is the responsibility of an officer or
employee who is eligible to join an opt-out plan or who is ineligible to
continue participation in the opt-out plan or the administrator of the opt-out
plan to notify the Program of the eligibility or ineligibility, as applicable,
of the officer or employee to participate in an opt-out plan. Failure to
provide such notification to the Program may result in the ineligibility of the
employee to participate in an opt-out plan or the Program, as applicable. Such
notification must be given to the Program within 60 days after the officer or
employee has become:

(a) Eligible to join an opt-out plan; or

(b) Ineligible to continue participation in an
opt-out plan,

Ê as
applicable.

6. The Program shall not consider a decision
by an officer or employee to join an opt-out plan to be a declination of
coverage.

7. No lapse in coverage may occur to an
officer or employee when he or she changes coverage pursuant to this section.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

1. Within 15 calendar days after a change in
the status of a participant in an opt-out plan that affects the rate of his or
her premium or contribution, the opt-out plan shall notify the Program of that
change in an electronic format acceptable to the Program.

2. If an officer or employee has declined
participation in an opt-out plan, the officer or employee shall notify the
Program within 60 days after the officer or employee has:

(a) Been ordered to obtain health insurance for his
or her child pursuant to NRS
31A.350; or

(b) A change in life status or the addition of a
dependent that initiates eligibility for both the declined employee and any
affected dependent.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

NAC 287.375Eligibility for coverage under opt-out plan: Administration of
requirements by Program; compliance with determinations of Program. (NRS 287.043, 287.0479)

1. The Program shall administer the
requirements for eligibility for coverage set forth in this chapter and chapter 287 of NRS for participants in
opt-out plans, including, without limitation:

(a) Processing notice of termination, workers’
compensation leave, military leave, family and medical leave and leave without
pay and any related changes that affect coverage.

(b) Processing an order for an officer or employee
to obtain health insurance for his or her child pursuant to NRS 31A.350.

2. An opt-out plan shall comply with
determinations of eligibility made by the Program regarding participants in the
opt-out plan.

NAC 287.376Participation in Program by certain persons eligible for coverage
under or participating in opt-out plan prohibited; exceptions. (NRS 287.043, 287.0479)

1. A retired officer or employee, and any dependent
thereof, who is eligible for coverage under an opt-out plan at the time of his
or her retirement may not elect to participate in the Program unless the group
which participates in the opt-out plan applies to reenter the Program pursuant
to NAC 287.400.

2. When a participant in an opt-out plan
becomes a survivor of a deceased officer or employee, the participant:

NAC 287.379Options for coverage under opt-out plan: Annual notification of
Program; effective period. (NRS 287.043, 287.0479)At least
90 days before the commencement of a new plan year of an opt-out plan, the
opt-out plan shall notify the Program of the options for coverage that will be
offered to participants in the opt-out plan during that plan year, including,
without limitation, the schedules of the rates for premiums or contributions in
accordance with the tiers of coverage established by the Program. Such options
for coverage and schedules of rates must remain in effect throughout the entire
new plan year.

1. The Program shall maintain the rates for
premiums or contributions for participants in each opt-out plan separately in
its information system.

2. The Program shall calculate the State’s
share of the costs of premiums or contributions for participants in an opt-out
plan pursuant to NRS 287.046 in
the same manner as for participants in the Program.

3. The difference between the amount of the
premium or contribution of a participant in an opt-out plan and the amount paid
by the State toward the premium or contribution of the participant pursuant to NRS 287.046 must be assessed to the
participant.

4. If the amount paid by the State toward
the premium or contribution of a participant in an opt-out plan pursuant to NRS 287.046 exceeds the amount of
the premium or contribution for that participant, the Program shall retain the
balance.

NAC 287.383Premiums or contributions for participants in opt-out plans:
Requirements for billing. (NRS 287.043, 287.0479)The
Program shall bill on a monthly basis:

1. Each payroll center that deducts and pays
the premium or contribution for a participant in an opt-out plan from the
salary or monthly retirement allowance, as applicable, of the participant for
the amount of the premiums or contributions for such participants based on the
schedule of rates for premiums or contributions for that opt-out plan.

2. Each participant in an opt-out plan that
is responsible for the paying of his or her premium or contribution directly.

3. The Retired Employees’ Group Insurance
Budget Account in the State Retirees’ Health and Welfare Benefits Fund created
by NRS 287.0436 for the portion
of the amount of the premiums or contributions for participants in an opt-out
plan who retired from the service of the State that is paid by the State
pursuant to subsection 2 of NRS
287.046. The Program shall identify separately the portion of the amount
billed to the State pursuant to this subsection that is attributable to
participants in each opt-out plan.

4. The Active Employee Group Insurance
Subsidy Account established pursuant to subsection 7 of NRS 287.044 within the Agency Fund
for the Payroll of the State created by NRS 227.130 for the portion of the
amount of the premiums or contributions for participants in an opt-out plan
that is paid by the State pursuant to subsection 1 of NRS 287.044. The Program shall
identify separately the portion of the amount billed to the State pursuant to
this subsection that is attributable to participants in each opt-out plan.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

NAC 287.385Premiums or contributions for participants in opt-out plans:
Remittance or transfer of payments; nonpayment by participant. (NRS 287.043, 287.0479)

1. A payroll center shall remit by the 25th
of each month to the Program the amount of the premiums or contributions for
participants in opt-out plans that is billed to the payroll center for that
month by the Program pursuant to subsection 1 of NAC
287.383. The payroll center shall identify separately the portion of each
such payment to the Program that is attributable to participants in each
opt-out plan.

2. A participant of an opt-out plan that is
billed directly by the Program pursuant to subsection 2 of NAC 287.383 for his or her premiums or contributions
shall remit the amount of the premium or contribution within 30 days after he
or she was billed.

3. The amount of the premiums or
contributions for participants in an opt-out plan for which the Retired
Employees’ Group Insurance Budget Account is billed each month pursuant to
subsection 3 of NAC 287.383 must be transferred to
the Program by the 25th day of each month, subject to adequate funding in that
Account.

4. The amount of the premiums or
contributions for participants in an opt-out plan for which the Active Employee
Group Insurance Subsidy Account is billed each month pursuant to subsection 4
of NAC 287.383 must be transferred to the Program
by the 25th day of each month, subject to adequate funding in that Account.

5. The Program shall notify an opt-out plan
of the nonpayment of a premium or contribution by a participant in the opt-out
plan who is billed by the Program for his or her premiums or contributions
directly or through a payroll center. The Program shall not initiate
termination of coverage of such a participant.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R097-03, eff. 9-24-2003; A by R002-12, 6-29-2012)

NAC 287.386Liability of Program and opt-out plan for expense or claim of
officer or employee or retired officer or employee, or dependent thereof. (NRS 287.043, 287.0479)

1. The Program is not liable for any expense
or claim of an officer or employee or retired officer or employee, or any
dependent thereof, who is a member of a group that is covered by an opt-out
plan if the expense or claim is incurred after the date on which the officer or
employee or retired officer or employee becomes eligible for coverage by the
opt-out plan.

2. An opt-out plan is not liable for any
expense or claim of an officer or employee or retired officer or employee, or
any dependent thereof, who is eligible for coverage by the Program if the
expense or claim is incurred after the date on which the officer or employee or
retired officer or employee becomes eligible for coverage by the Program.

1. To recoup the administrative costs
incurred by the Program related to opt-out plans, the Program shall, for each
fiscal year, establish a monthly per capita administrative fee to be charged to
each opt-out plan for each participant in the opt-out plan.

2. The administrative fee charged to each
opt-out plan each month pursuant to subsection 1 must be based on the number of
participants in the opt-out plan during that month.

3. The per capita administrative fee must be
calculated by:

(a) Subtracting from the amount of the annual
budget of the Program:

(1) Consulting fees incurred by the Program for
health benefits for participants in the Program;

(2) Fully insured costs of the Program;

(3) Administrative costs for the plan of
self-insurance of the Program;

(4) Expenses for claims made by participants
in the plan of self-insurance of the Program;

(5) Reserve expenses for the plan of
self-insurance of the Program; and

(6) Any other costs incurred by the Program
that the Program deems to be unrelated to participants in opt-out plans.

(b) Dividing the number determined pursuant to
paragraph (a) by the total number of persons who are participating in the
Program or in an opt-out plan during the 10th month of the fiscal year
immediately preceding the fiscal year for which the fee is being established.

(c) Dividing the number determined pursuant to
paragraph (b) by 12.

4. The administrative fee must be calculated
and provided in writing to each opt-out plan not later than 60 days before the
beginning of each fiscal year.

NAC 287.400Procedure for applying to reenter Program. (NRS 287.043, 287.0479)A group
that was approved to leave the Program pursuant to NRS 287.0479 may apply to reenter
the Program by submitting to the Board a completed application on a form
prescribed by the Board at least 90 days before the commencement of the plan
year in which reentry is desired. The application must include, without
limitation:

1. A nonrefundable application fee of
$250.00, plus $2.25 per participant in the opt-out plan.

2. A nonrefundable fee to be deposited in
the Fund for the Public Employees’ Benefits Program created pursuant to NRS 287.0435 for the purpose of
funding the reserve maintained by the Program to stabilize rates. The Executive
Officer or his or her designee shall calculate the amount of the nonrefundable
fee by:

(a) Dividing the funded reserve maintained by the
Program to stabilize rates on the date on which the application was submitted
by the total number of participants in the Program on that date; and

(b) Multiplying the number determined pursuant to
paragraph (a) by the total number of participants in the opt-out plan who will
reenter the Program.

Ê The fees or
the first installment payment of the fees, if installment payments are
authorized by the Program, must be paid by the effective date of reentry.

1. The total of the premiums or
contributions which is billed by the Program and is owed by a public employer
which:

(a) Employs an officer or employee;

(b) Is legally responsible for the surviving spouse
or child of a police officer, firefighter or volunteer firefighter killed in
the line of duty; or

(c) Pays a subsidy for any of its retired officers
or employees,

Ê for the
officer, employee, surviving spouse or child, or retired officer or employee
who elects to participate in the Program and the respective premium or
contribution, if any, which is deducted from his or her compensation must be
received by the Program by the 25th of each month.

2. If a public employer does not pay the
amount billed by the Program, the Program shall determine if a penalty that is
based on the amount actually paid should be assessed. If the total payments
made by the public employer were less than the amount billed to the public
employer, the Program may, for good cause shown, assess a monthly compounded
penalty of 1.5 percent of the unpaid balance, which will include, without
limitation, any unpaid subsidies, penalties or adjustments.

3. For the purposes of this section, if the
25th day of the month is a Saturday, Sunday or legal holiday, the payment of a
premium or contribution is timely if it is received on the next day which is
not a Saturday, Sunday or legal holiday.

(Added to NAC by Com. on Group Ins., eff. 5-27-86; A 12-17-87;
A by Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by
R126-00, 12-22-2000, eff. 1-1-2001; R154-03, 3-22-2004; R107-09, 4-20-2010)

NAC 287.430Direct payment of premiums or contributions: Date due;
cancellation of coverage. (NRS 287.043, 287.046)A
person, other than a person who elects to continue coverage pursuant to the
Public Health Service Act, 42 U.S.C. § 300bb-1(a), who:

1. Enrolls, reenrolls, joins or is
continuing coverage in the Program; and

2. Is responsible for the payment of the
premium or contribution for group insurance directly to the Program or an
insurer,

Ê shall pay the
premium or contribution to the Program or insurer, as appropriate, no later
than the date which is 30 days after the due date of the payment, as determined
by the Program. If the total amount of the premium or contribution is not
received by that date, the coverage will be cancelled effective on the last day
of the month that the coverage was fully paid unless the particular contract of
coverage or insurance for which payment is being made otherwise provides.

(Added to NAC by Com. on Group Ins., eff. 5-27-86; A 12-17-87;
A by Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by
R126-00, 12-22-2000, eff. 1-1-2001; R154-03, 3-22-2004; R089-05, 6-28-2006;
R107-09, 4-20-2010)

1. Except as otherwise provided in subsection
2, retired officers and employees shall pay their premiums or contributions
directly to the Program.

2. Retired officers and employees who
receive a retirement benefit from the Public Employees’ Retirement System shall
pay their premiums or contributions to the Program through an automatic
deduction from that benefit unless the:

(a) Retirement benefit is less than the premium or
contribution; or

(b) Coverage of the retired officer or employee is
provided through the Program by an individual medical care plan offered through
an exchange to supplement Medicare.

NAC 287.450Employees on leave without pay: Payment of premiums or
contributions; eligibility for coverage as dependent of participant; coverage
upon return to work. (NRS 287.043, 287.046)

1. A participating public agency that
employs an employee who is on leave without pay shall not pay any amount of the
cost of premiums or contributions that is due the Program for group insurance
for that employee unless the employee is compensated for a combination of work
actually performed and accrued annual leave or sick leave, if the total is at
least 80 hours per month for each month that coverage or insurance is provided.

2. An employee who is on approved leave
without pay:

(a) May continue coverage or insurance for himself
or herself and any of his or her eligible dependents:

(1) If the amount of the paycheck of the
employee is more than the cost of the premium or contribution, by having the
cost of the premium or contribution deducted from his or her paycheck; or

(2) If the amount of the paycheck of the
employee is less than the cost of the premium or contribution, by paying the
cost of the premium or contribution directly to the Program.

(b) Is not eligible for coverage or insurance as a
dependent of a participant.

(c) Is not eligible for coverage or insurance if
the employee elects not to pay the premium or contribution for coverage or
insurance.

3. If an employee who is on approved leave
without pay elects not to pay the premium or contribution for coverage and
insurance from the Program and returns to work:

(a) Within 1 year after the last day of his or her
coverage from the Program, the employee is not required to complete 90 days of
full-time employment before being eligible to participate in the Program.

(b) One year or more after taking leave without
pay, the employee is eligible to participate in the Program on the first day of
the month following 90 days of full-time employment.

4. An employee who is on approved leave
without pay may, at the time he or she returns to work, obtain coverage and
insurance for any dependent who was previously covered.

NAC 287.460Officers and employees on leave because of injuries in course of
employment: Payment of premiums or contributions; reports of change in status;
coverage of dependents upon return to work. (NRS 287.043, 287.0439, 287.0445)

1. An officer or employee of a participating
public agency who:

(a) Is on leave because he or she was injured in
the course of employment;

(b) Receives compensation for a temporary total
disability pursuant to NRS
616C.475; and

(c) Was a participant in the Program at the time of
the injury,

Ê may continue
coverage or insurance for himself or herself and any of his or her eligible
dependents by having the cost of the premium or contribution deducted from his
or her paycheck if the amount of the paycheck is more than the cost of the
premium or contribution or, if the amount of the paycheck is less than the cost
of the premium or contribution, by paying the cost of the premium or
contribution directly to the Program. The officer or employee shall report the
change of status to the participating public agency that employs him or her
when he or she takes leave and when he or she returns to work. Within 15 days
after notification of such a change of status by the officer or employee, the
participating public agency shall report to the Program, on a form prescribed
by the Program, the change of status of the officer or employee.

2. If the officer or employee does not pay
for coverage or insurance for his or her dependent while on leave and returns
to work within 1 year after the last day of his or her coverage from the
Program, the dependent may be covered.

1. The provisions of this section apply if
an overpayment or underpayment of a premium or contribution occurs because of:

(a) A clerical error by the Program or a
participating public agency;

(b) A change of coverage or a change in the working
status of a participating officer or employee; or

(c) The failure of a participant to give timely
notice that a dependent is ineligible for coverage.

2. If a participating public agency makes an
overpayment of premiums or contributions, it may deduct the amount of the
overpayment from the payment of premiums or contributions otherwise due for the
following month. Any such deduction for a period greater than 1 month must:

(a) Be approved in advance by the Program; and

(b) Equal the amount of the overpayment without
provision for interest.

3. The participating public agency shall pay
any money due a participant because of an overpayment of premiums or
contributions.

4. If a participating public agency makes an
underpayment of premiums or contributions, it must add the amount of the
underpayment to the payment of premiums or contributions otherwise due for the
following month. Any such additions for a period greater than 1 month must:

(a) Be approved in advance by the Program; and

(b) Equal the amount of the underpayment without
provision for interest.

5. Any money owed by a participant because
of an underpayment of premiums or contributions must be collected from the
participant and paid by the participating public agency.

6. As used in this section, “overpayment of
premiums or contributions” does not include the payment of premiums or
contributions for the month in which the employment of a participant
terminated, regardless of the date on which the termination occurs.

NAC 287.485Subsidy for retired officer or employee: Report required to
obtain subsidy; audit of service credit required; billing; commencement of
payment; adjustment of amount of subsidy; assumption of liability for service
credit earned. (NRS 287.043, 287.046)

1. To obtain a subsidy, a retired officer or
employee who participates in the Program must report to the Program, on a form
prescribed by the Program, each public employer with which he or she earned
service credit and the period of service with each such public employer.

2. The Executive Officer or a designee
thereof shall request an audit from the appropriate certifying agency to
determine the initial date of hire of a retired officer or employee and the
years and months of service credit earned by the retired officer or employee
with each public employer of the retired officer or employee during the period
of that employment. Such a request must be made within 14 days after the later
of:

(a) The receipt of the report made to the Program
pursuant to subsection 1; or

(b) Must include any service credit that has been
restored by the repayment of contributions that the retired officer or employee
had withdrawn from the Public Employees’ Retirement System pursuant to NRS 286.430; and

(c) Must not include any service credit that was
purchased pursuant to NRS 1A.310
or 286.300.

4. Except as otherwise provided in
subsection 5, the Executive Officer or a designee thereof shall not submit a
bill to a public employer for a subsidy for a retired officer or employee until
an audit requested pursuant to subsection 2 for the retired officer or employee
is received by the Program.

5. If an audit requested pursuant to
subsection 2 is received after the date on which coverage of the retired
officer or employee becomes effective, the Executive Officer or a designee
thereof shall submit to the previous public employer of the retired officer or
employee a bill for the subsidy incurred between the date on which coverage of
the retired officer or employee became effective and the date on which the audit
was received.

6. A public employer shall commence payment
of its subsidy for a retired officer or employee upon receipt of the bill for
the subsidy.

7. If, after receiving an audit requested
pursuant to subsection 2, the Program receives any additional audit for the
retired officer or employee for whom the original audit was conducted:

(a) The Program shall adjust the amount to be
billed to the retired officer or employee and to the previous public employer
of the retired officer or employee according to the years and months of service
credit reported in the most recent audit; and

(b) Any such adjustment will be effective on the
first day of the month after the receipt by the Program of the most recent
audit.

8. A public employer or other entity may
assume from a public employer the liability for the years and months of service
credit earned by a retired officer or employee if the public employer assuming
the liability submits a written certification to the Program containing:

(a) The name and social security number of the
retired officer or employee;

(b) The dates during which the service credit for
which the public employer or other entity is assuming liability was earned by
the retired officer or employee;

(c) A statement acknowledging that the public
employer or other entity is assuming the liability associated with the dates
listed pursuant to paragraph (b);

(d) A signature of the director or chief executive
officer of the public employer or other entity assuming liability, or a
designee of the director or chief executive officer of the public employer or
other entity assuming liability; and

(e) The name, title and contact information of the
person who signed the certification.

9. If a public employer with which a retired
officer or employee earned service credit ceases to exist as a public employer,
the public employer that has the most direct jurisdictional association with
the public employer that ceases to exist, as determined by the Executive
Officer, shall assume liability for the years and months of service credit
earned by the retired officer or employee with the public employer that ceases
to exist.

10. The results reported in an audit
received by the Program pursuant to the provisions of this section may not be
appealed.

1. Except as otherwise provided in
subsection 2, the amount of the subsidy that must be paid by each public
employer with which a retired officer or employee was employed is calculated in
the manner set forth in NRS 287.046.

2. Each public employer with which the
retired officer or employee was employed shall pay an amount of the total
subsidy for the retired officer or employee equal to the proportion that the
service credit earned by the retired officer or employee with that public
employer bears to the total service credit earned by the retired officer or
employee with all public employers with which the retired officer or employee
was employed. The amount of the total subsidy must be based on the cumulative
total years and months of service by the retired officer or employer for all public
employers with which the retired officer or employee was employed.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R154-03, 3-22-2004, eff. 7-1-2004; A by R126-07, 1-30-2008)

1. If a seasonal employee returns to work
with a participating public agency, the participating public agency shall
determine if the employee participated in the Program or was eligible to
participate during his or her previous employment with the participating public
agency.

2. A seasonal employee who was eligible to
participate in the Program during his or her previous employment with a
participating public agency and who returns to work within 1 year after the
termination of employment is eligible to participate in the Program on the
first day of the month following his or her return to work.

3. A seasonal employee who returns to work 1
year or more after the termination of his or her previous employment is
eligible to participate in the Program:

(a) If the first day after the completion of 90
days of full-time employment is the first day of a month, on the first day
after the completion of 90 days of full-time employment; or

(b) If the first day after the completion of 90
days of full-time employment is not the first day of a month, on the first day
of the month immediately following the completion of 90 days of full-time
employment.

4. A biennial employee who was working for a
participating state agency is not subject to any waiting period upon
reenrollment if the biennial employee:

(a) Is returning to the same or a similar position
as held during the previous biennial employment period; and

(b) Continues to pay his or her full premium or
contribution and allowable administrative fees as required by NRS 287.0467 for the enrolled
coverage between biennial employment periods.

NAC 287.510Coverage of persons returning to work with previous employer
within 1 year after leaving employment. (NRS 287.043, 287.045)If a
person other than a retired officer or employee returns to work for a
participating public agency with which the person was previously employed
within 1 year after leaving employment:

1. The person may select any coverage and
insurance offered to participants in the Program at the time that the person
returns to work; and

2. Coverage and insurance for the person is
effective:

(a) If the effective date of reemployment is on the
first day of a month, on the effective date of reemployment; or

(b) If the effective date of reemployment is not on
the first day of a month, on the first day of the month immediately following
the effective date of reemployment.

1. Except as otherwise provided in this
section, a person who participates in the Program as a retired officer or
employee and who returns to full-time employment with a participating public
agency is eligible to participate in the Program as an active officer or
employee:

(a) If the effective date of reemployment is on the
first day of a month, on the effective date of reemployment; or

(b) If the effective date of reemployment is not on
the first day of a month, on the first day of the month immediately following
the effective date of reemployment.

2. If a person who participates in the
Program as a retired justice or judge accepts reemployment as a justice of the
Supreme Court or district judge pursuant to NRS 1A.370, the person is
eligible to participate in the Program as an active justice or judge, as
applicable:

(a) If the first day after the completion of 90
days of full-time employment is on the first day of a month, on the first day
after the completion of 90 days of full-time employment; or

(b) If the first day after the completion of 90
days of full-time employment is not on the first day of a month, on the first
day of the month immediately following the completion of 90 days of full-time
employment.

3. Except as otherwise required by federal
law, a retired officer or employee who returns to full-time employment with a
participating public agency to fill a position which has been designated as a
position for which there is a critical labor shortage pursuant to NRS 286.523 and who continues to
receive allowances under the retirement system of which he or she is a member
is eligible to participate in the Program in the same manner as he or she
participated before returning to full-time employment. Except for a retired
officer or employee who was enrolled in the Program on November 30, 2008, and
continues his or her participation in the Program, coverage of a retired
officer or employee who returns to full-time employment with a participating
local governmental agency pursuant to this subsection terminates on the date on
which the participating local governmental agency terminates its participation
in the Program.

4. A retired officer or employee who returns
to full-time employment with a participating state agency to fill a position
which has been designated as a position for which there is a critical labor
shortage pursuant to NRS 286.523
and who discontinues receiving allowances under the retirement system of which
he or she is a member is eligible to participate in the Program as an active
officer or employee:

(a) If the effective date of reemployment is on the
first day of a month, on the effective date of reemployment; or

(b) If the effective date of reemployment is not on
the first day of a month, on the first day of the month immediately following
the effective date of reemployment.

5. A retired officer or employee who returns
to full-time employment with a participating local governmental agency to fill
a position which has been designated as a position for which there is a
critical labor shortage pursuant to NRS
286.523 and who discontinues receiving allowances under the retirement system
of which he or she is a member is eligible to participate in the Program as an
active officer or employee:

(a) If the effective date of reemployment is on the
first day of a month, on the effective date of reemployment; or

(b) If the effective date of reemployment is not on
the first day of a month, on the first day of the month immediately following
the effective date of reemployment.

Ê Except for a
retired officer or employee who was enrolled in the Program on November 30,
2008, and continues his or her participation in the Program, coverage of a
retired officer or employee pursuant to this subsection terminates on the date
on which the participating local governmental agency with which the retired
officer or employee returns to full-time employment terminates its
participation in the Program.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R089-05, eff. 6-28-2006; A by R126-07, 1-30-2008; R108-12, 12-20-2012)

NAC 287.520Coverage of person qualified as both employee and dependent;
change of status from employee to dependent. (NRS 287.043)

1. Except as otherwise provided in NAC 287.530, if a person qualifies to be covered by
the Program as both an employee and a dependent, the person:

(a) If the person is a spouse or domestic partner:

(1) May be covered by the Program as an
employee; and

(2) May not be covered by the Program as a
dependent.

(b) If the person is a child, may be covered by the
Program as an employee or dependent.

2. If a participating officer or employee
changes his or her status to that of a dependent because he or she no longer
qualifies as an employee, he or she must enroll as a dependent within 60 days
after losing status as an employee to be eligible for coverage and insurance as
a dependent. If a participant complies with the requirements of this
subsection, his or her coverage or insurance is not limited by any waiting
period that would otherwise apply.

(Added to NAC by Com. on Group Ins., eff. 5-27-86; A by
Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by R126-00,
12-22-2000, eff. 1-1-2001; R002-12, 6-29-2012)

1. If the participant and his or her spouse
or domestic partner are retired officers or employees who retired before July
1, 2004, and elect to participate in the Program, one may elect to be the
dependent of the other. A spouse or a domestic partner who elected to be the
dependent pursuant to this subsection may elect to become a primary insured
during open enrollment. If the retired officer or employee designated as the
primary insured dies, the spouse or domestic partner who elected to be the
dependent becomes the primary insured.

2. A person who retires on or after July 1,
2004, and who is eligible to participate in the Program as a primary insured
may not elect to be a dependent of his or her spouse or domestic partner who is
a primary insured in the Program.

3. A surviving spouse or domestic partner
who:

(a) Retired before July 1, 2004;

(b) Is enrolled in the Program as a surviving
dependent; and

(c) Is eligible to participate in the Program as a
primary insured,

Ê may elect to
change his or her status to retiree status during open enrollment. A person who
chooses such an election pursuant to this subsection must meet the requirements
of NAC 287.485 to be eligible for a subsidy.

4. A person who is a surviving dependent of
a deceased officer or employee of a participating public agency, or a deceased
retired officer or employee, and who, at the time of his or her death, was a
participant under the Program, may maintain the coverage or insurance from the
Program if:

(a) The surviving dependent receives retirement
benefits from which premiums or contributions can be deducted or such dependent
pays the premium or contribution directly to the Program; and

(b) Within 60 days after the date of death of the
participant, the surviving dependent:

(1) Notifies the last public employer of the
deceased participant that the surviving dependent intends to enroll in or
continue coverage by reenrolling in the Program; and

(2) Enrolls or reenrolls, as appropriate, in
the Program.

5. Continued coverage provided to a
surviving dependent who reenrolls in the Program in accordance with this
section may not be changed until the next period of open enrollment.

6. If the surviving spouse or domestic
partner has a dependent who is not covered under the Program at the time of
death of the officer or employee of a participating public agency, or retired
officer or employee, or acquires a dependent by marriage, adoption or birth,
the dependent is not eligible for coverage or insurance.

7. A retired officer or employee who wishes
to enroll or reenroll in the Program more than 60 days after his or her
official date of retirement or total disability must comply with the
requirements of NRS 287.0475.

NAC 287.540Coverage of participating
employee of State who reenrolls upon retirement or total disability; coverage
of nonparticipating employee of State. (NRS
287.043)

1. A person who:

(a) At the time of retirement or total disability,
was:

(1) Employed by a participating state agency;
and

(2) A participant in the Program; and

(b) Within 60 days after the official date of retirement
or total disability reenrolls in the Program,

Ê will have
uninterrupted benefits and is not subject to any waiting period.

2. A person described in subsection 1 may
select any coverage and insurance offered to participants in the Program at the
time of reenrollment pursuant to paragraph (b) of subsection 1.

3. A person who, at the time of retirement
or total disability, was:

(a) Employed by a participating state agency; and

(b) Not a participant in the Program,

Ê may only
reinstate in the Program pursuant to the provisions of NRS 287.0475.

4. Coverage provided to a person described
in subsection 1 or 3 will continue until he or she chooses to terminate or
decline the coverage. If the person chooses to terminate or decline the
coverage, he or she may subsequently only reinstate in the Program pursuant to
the provisions of NRS 287.0475.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R126-07, eff. 1-30-2008; A by R108-12, 12-20-2012)

NAC 287.542Coverage of participating employee of local governmental agency
who retires on or before September 1, 2008, and reenrolls upon retirement or
total disability. (NRS 287.043)

1. A person who:

(a) Is a retired officer or employee on or before
September 1, 2008;

(b) At the time of retirement or total disability,
was:

(1) Employed by a participating local
governmental agency; and

(2) A participant in the Program; and

(c) Within 60 days after the official date of
retirement or total disability:

(1) Notifies the participating local
governmental agency that employed him or her at the time of retirement or total
disability of his or her intent to continue coverage in the Program; and

(2) Reenrolls in the Program,

Ê will have
uninterrupted benefits and is not subject to any waiting period.

2. Coverage provided to a person described
in subsection 1:

(a) May be changed by the person at the time of
reenrollment pursuant to subparagraph (2) of paragraph (c) of subsection 1.

(b) Continues until the person chooses to terminate
or decline the coverage. If the person chooses to terminate or decline the
coverage after November 30, 2008, the person may subsequently only reinstate in
the Program pursuant to NRS 287.023
and 287.0475.

NAC 287.544Coverage of nonparticipating employee of local governmental
agency who retires on or before September 1, 2008, and enrolls upon retirement
or total disability. (NRS 287.043)

1. A person who:

(a) Is a retired officer or employee on or before
September 1, 2008;

(b) At the time of retirement or total disability:

(1) Was employed by a participating local
governmental agency; and

(2) Was not a participant in the Program; and

(c) Within 60 days after the official date of
retirement or total disability:

(1) Notifies the participating local
governmental agency that employed him or her at the time of retirement or total
disability of his or her intent to enroll in the Program; and

(2) Enrolls in the Program,

Ê is subject to
a 60-day waiting period.

2. Coverage provided to a person described
in subsection 1 continues until the person chooses to terminate or decline the
coverage. If the person chooses to terminate or decline the coverage after
November 30, 2008, the person may subsequently only reinstate in the Program
pursuant to NRS 287.023 and 287.0475.

NAC 287.546Coverage of participating employee of local governmental agency
who retires after September 1, 2008, and reenrolls upon retirement or total
disability. (NRS
287.043)

1. A person who:

(a) Becomes a retired officer or employee after
September 1, 2008;

(b) At the time of retirement or total disability,
was:

(1) Employed by a participating local
governmental agency; and

(2) A participant in the Program; and

(c) Within 60 days after the official date of
retirement or total disability reenrolls in the Program,

Ê will have
uninterrupted benefits and is not subject to any waiting period.

2. Continued coverage provided to a person
described in subsection 1 may be changed by the person at the time of
reenrollment pursuant to paragraph (c) of subsection 1.

3. Coverage of a person pursuant to this
section terminates on the date on which the participating local governmental
agency that employed the person at the time of retirement or total disability
terminates its participation in the Program.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R126-07, eff. 1-30-2008; A by R108-12, 12-20-2012)

NAC 287.548Coverage of nonparticipating employee of local governmental
agency who retires after September 1, 2008. (NRS 287.043)

1. A person who:

(a) Becomes a retired officer or employee after
September 1, 2008; and

(b) At the time of retirement or total disability:

(1) Was employed by a participating local
governmental agency; and

(2) Was not a participant in the Program,

Ê may only
reinstate in the Program pursuant to the provisions of NRS 287.0475.

2. Coverage provided to a person pursuant to
this section terminates on the date on which the participating local
governmental agency that employed the person at the time of retirement or total
disability terminates its participation in the Program.

(Added to NAC by Bd. of Pub. Employees’ Benefits Prog.
by R126-07, eff. 1-30-2008; A by R108-12, 12-20-2012)

NAC 287.603“Claims Administrator” defined. (NRS 287.043)“Claims
Administrator” means a third-party administrator with which the Program has
entered into a contract pursuant to NRS
287.0434 to administer the claims of participants of the Program.

NAC 287.610Period for submission. (NRS 287.043)A claim
made to the Program must be submitted to the Claims Administrator of the
Program not later than 1 year after the date on which the expense reported in
the claim is incurred. A claim submitted after that time will not be paid.

1. If a medical claim is made by a retired
participant who is 65 years of age or older, the Claims Administrator shall
assume that benefits are available to the participant pursuant to Medicare Part
B. To coordinate benefits under Medicare for the purposes of this subsection,
the Claims Administrator shall use the first day of the month in which the
birthday of the retired participant occurs.

2. If the Claims Administrator receives
notification that a retired participant who is less than 65 years of age is
eligible for benefits pursuant to Medicare Part B, the Claims Administrator
shall coordinate benefits under Medicare using the first day of the month in
which he or she receives notification that the retired participant is eligible
for such benefits.

(Added to NAC by Com. on Benefits, eff. 5-4-92; A by
Bd. of Pub. Employees’ Benefits Prog. by R108-12, 12-20-2012)

1. Except as otherwise provided in NAC 287.695, to initiate an appeal of an adverse
determination of a claim, a participant must submit a written request to the
Claims Administrator within 180 days after the date on which the participant
received the notification of the adverse determination that is required
pursuant to NAC 287.660. A request for an appeal of
an adverse determination must include:

(a) The name of the participant;

(b) The social security number or member
identification number of the participant;

(c) A copy of the explanation of benefits related
to the claim that was provided to the participant by the Claims Administrator;

(d) A copy of the claim that was submitted to the
Claims Administrator from the vendor; and

(e) A statement setting forth the reasons the
adverse determination is being appealed.

2. The Appeals Manager of the Claims
Administrator shall:

(a) Review the appeal of an adverse determination
to decide if the claim was adjudicated pursuant to the:

(1) Current terms and conditions of the
Program; and

(2) Contract between the Program and
applicable vendor; and

(b) Within 20 days after receiving the request for
an appeal, advise the participant in writing of:

(1) The decision of the Appeals Manager,
setting forth the reasons therefor;

(2) The specific provision of the applicable
plan of the Program used by the Appeals Manager as the basis for the decision;
and

(3) The process by which the participant may
appeal the decision of the Appeals Manager pursuant to NAC
287.680.

3. As used in this section, “member
identification number” means the number assigned to a participant by the
Program.

1. Except as otherwise provided in NAC 287.695, if a participant in the Program is
unsatisfied with the decision of the Appeals Manager made pursuant to NAC 287.670, the participant may file an appeal with
the Executive Officer or a designee thereof. Such an appeal must be in writing
and be filed within 35 days after the participant’s receipt of the decision of
the Appeals Manager. Such an appeal must include all supporting documentation,
including, without limitation, a copy of the request for an appeal of the
adverse determination submitted to the Claims Administrator pursuant to NAC 287.670, a copy of the decision of the Appeals
Manager concerning the adverse determination and any other information provided
to the Claims Administrator by the participant.

2. The Executive Officer or the designee
shall:

(a) Review the material submitted by the
participant to decide if the claim was adjudicated pursuant to the:

(1) Current terms and conditions of the
Program; and

(2) Contract between the Program and
applicable vendor; and

(b) Within 30 days after receipt of the
participant’s appeal, notify the participant in writing of:

(1) The decision of the Executive Officer or
the designee, setting forth the reasons therefor;

(2) The specific provision of the applicable
plan of the Program used by the Executive Officer or the designee as a basis
for the decision; and

(3) The process by which the participant may
request an external review of the adverse determination pursuant to NAC 287.690.

(Added to NAC by Com. on Group Ins., eff. 3-9-88; A by
Com. on Benefits, 5-4-92; A by Bd. of Pub. Employees’ Benefits Prog. by R126-00,
12-22-2000, eff. 1-1-2001; R154-03, 3-22-2004; R126-07, 1-30-2008; R002-12, 6-29-2012)

NAC 287.690Request for external review. (NRS 287.043)If a
participant in the Program is not satisfied with the decision of the Executive
Officer or the designee on the appeal made by the participant pursuant to NAC 287.680, the participant may request an external
review of the adverse determination conducted by an independent review
organization pursuant to NRS
695G.241 to 695G.310,
inclusive.

1. In addition to the expedited procedure
set forth in NRS 695G.271 and 695G.275, a participant may
submit a request, verbally or in writing, to the Claims Administrator for an
expedited review of an adverse determination under the circumstances set forth
in NRS 695G.271 and 695G.275.

2. Any information related to such a request
for an expedited review may be transmitted between the participant and the
Claims Administrator by telephone, facsimile or other expeditious method of
communication.

3. The Claims Administrator shall notify the
participant in writing of its determination on the request for an expedited
review within 72 hours after the request was made to the Claims Administrator.

1. “Committee” means the Committee
established to administer the Program.

2. “Investment consultant” means a private
person, corporation, institution or other entity that provides advice on
investments and operations of the Program, including, without limitation,
advice provided for the purposes of paragraph (a) of subsection 3 of NRS 287.330 and NAC 287.735.

3. “Program” means the Public Employees’
Deferred Compensation Program authorized by NRS 287.250 to 287.370, inclusive.

4. “Recordkeeper” means a corporation,
institution or other entity that offers investment options and other services
which are necessary to the administration of the Program and to the proper
investment of the money of the employees who are participants in the Program.
The term does not include a private person.

1. The Committee will select recordkeepers
for the Program. The Committee will contract with more than one recordkeeper if
the Committee deems it necessary and in the best interests of the participants.

2. The selection of recordkeepers will be
made as often as the Committee deems necessary, but not less frequently than
every fifth year.

3. Recordkeepers serve at the pleasure of
the Committee and are subject to removal at any time by a majority vote of the
Committee.

NAC 287.715Recordkeepers: Procedures for selection. (NRS 287.330)In
selecting a recordkeeper, the Committee will follow the procedures set forth in
chapter 333 of NRS, the applicable
regulations and the State Administrative Manual.

NAC 287.730Appointment of subcommittee to review proposals for position of
recordkeeper and make recommendations; general meeting of Committee regarding
applicants; negotiation of changes to accepted proposals. (NRS 287.330)

1. The Chair shall, if he or she deems it
appropriate, appoint a subcommittee to review the proposals from applicants for
the position of recordkeeper and make recommendations to the full Committee.

2. The Chair shall call a general meeting of
the Committee to:

(a) Accept information from appropriate sources
pertaining to any applicant.

(b) Conduct interviews of the applicants.

(c) Select one or more of the applicants for
appointment as a recordkeeper.

3. Acceptance of an applicant’s proposal
does not preclude the Committee from negotiating specific changes to the
proposal which are in the best interests of the State of Nevada.

1. The Committee will select such investment
consultants as are necessary to provide services needed for the selection of
recordkeepers and for the administration of the Program and the investment of
the money of the participants.

2. Such an investment consultant serves at
the pleasure of the Committee and may be removed from the position at any time
by a majority vote of the Committee.

NAC 287.750System for resolving complaints of insureds: Requirements for
approval and annual report. (NRS 679B.130)If the
Board of the Public Employees’ Benefits Program provides health insurance
through a plan of self-insurance:

1. To obtain approval of a system for
resolving complaints of insureds under the plan of self-insurance from the
Commissioner of Insurance as required pursuant to NRS 287.04335 and 695G.200, the Board must submit
to the Division of Insurance of the Department of Business and Industry:

(a) The name and title of the employee responsible
for the system for resolving complaints;

(b) A description of the procedure used to notify
an insured of the decision regarding his or her complaint; and

(c) A copy of the explanation of rights and
procedures that will be provided to insureds.

2. The Board shall submit its annual report
regarding its system for resolving complaints to the Commissioner of Insurance
as required pursuant to NRS
287.04335 and 695G.220 on
or before February 1 of each year. The Board shall retain a copy of the annual
report for 3 years or until the next examination of the system for resolving
complaints is conducted by the Division pursuant to NRS 287.04335 and 695G.200, whichever is longer.

3. The Board is not required to include in
the annual report information concerning an oral inquiry by an insured relating
to a misunderstanding or miscommunication if the misunderstanding or
miscommunication was resolved within 1 working day after the inquiry was made.
If the misunderstanding or miscommunication was not resolved within 1 working
day, the Board shall report the misunderstanding or miscommunication as a
complaint in the annual report.

(Added to NAC by Comm’r of Insurance by R008-02, eff. 5-23-2002)

TRUST FUND FOR FUTURE RETIREMENT BENEFITS OF LOCAL
GOVERNMENTAL EMPLOYEES

NAC 287.760Definitions. (NRS 287.017)As used
in NAC 287.760 to 287.792,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 287.762 to 287.774,
inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

NAC 287.762“Benefits plan” defined. (NRS 287.017)“Benefits
plan” has the meaning ascribed to it in NRS 287.017.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

NAC 287.764“Board of trustees” defined. (NRS 287.017)“Board
of trustees” means the persons appointed by a governing body to administer a
trust fund established pursuant to NRS
287.017.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. A trust fund must be established by a
resolution of the governing body, which must include specific statements
regarding:

(a) The purpose of the trust fund;

(b) A statement that all contributions to the trust
fund, including any interest and income earned on the money in the trust fund,
are held in trust, are irrevocable and may be used only to:

(1) Provide, for the benefit of retired
employees of that local government and the spouses and dependents of those
employees, retirement benefits in accordance with the benefits plan of that
local government; and

(2) Pay any reasonable administrative expenses
incident to the provision of those benefits and the administration of the trust
fund;

(c) The sources of the money expected to be
deposited in the trust fund;

(d) The appointment by the governing body of a
board of trustees, including, without limitation, the number of members of the
board of trustees and their terms of office, as determined pursuant to NAC 287.778;

(e) A statement that the powers, duties, rights and
obligations of the board of trustees will conform to the requirements of NRS 287.017 and NAC 287.760 to 287.792,
inclusive;

(f) A statement that, except as otherwise provided
in paragraph (h) of subsection 2 of NRS
287.017, no other money will be commingled with the money in the trust fund
and that the trust fund will be maintained as a separate account; and

(g) A statement that the money in the trust fund
will not be used to finance debt of the local government and will not be
available for loans to other funds of the local government.

2. A copy of the resolution adopted pursuant
to subsection 1 must be filed with the Department of Taxation within 30 days
after its adoption by the governing body. The Department of Taxation shall
report at least annually to the Committee on Local Government Finance regarding
the trust funds established during the reporting period.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

(a) If the assets of the trust fund will only be
deposited in the Retirement Benefits Investment Fund pursuant to subparagraph
(1) of paragraph (g) of subsection 2 of NRS 287.017, the governing body
shall appoint at least three but not more than five persons to the board of
trustees, including:

(1) One or more persons who each have a
combination of education and experience in finance or economics that totals 5
years or more;

(2) A public officer or employee of the local
government who manages the fiscal affairs of the local government; and

(3) A beneficiary of the benefits plan of the
local government.

(b) If the assets of the trust fund will be
invested only in investments authorized for a local government pursuant to
subparagraph (2) of paragraph (g) of subsection 2 of NRS 287.017, or in such investments
and deposited in the Retirement Benefits Investment Fund pursuant to
subparagraph (1) of paragraph (g) of subsection 2 of NRS 287.017, the governing body
shall appoint at least three but not more than five persons to the board of
trustees, including:

(1) One or more persons who each have a
combination of education and experience in finance or economics that totals 5
years or more;

(2) A public officer or employee of the local
government who manages the fiscal affairs of the local government; and

(3) A beneficiary of the benefits plan of the
local government who has a combination of education and experience in finance
or economics that totals 5 years or more.

(c) If the assets of the trust fund qualify to be
invested pursuant to subsection 2 of NAC 287.790,
the governing body shall appoint five persons to the board of trustees,
including:

(1) Two persons who have experience in the
securities exchange market;

(2) A public officer or employee of the local
government who manages the fiscal affairs of the local government;

(3) A person who is not an employee of the
local government, who has a combination of education and experience in finance
or economics that totals 7 years or more; and

(4) A beneficiary of the benefits plan of the
local government who has a combination of education and experience in finance
or economics that totals 7 years or more.

2. A person may not be appointed to the
board of trustees pursuant to this section if the person:

(a) Has a substantial financial interest in the
ownership or negotiation of the securities or other financial instruments in
which the assets of the trust fund are invested.

(b) Is a member of the governing body that
established the trust fund.

3. A resolution adopted by two or more
governing bodies to form a pooled trust pursuant to paragraph (h) of subsection
2 of NRS 287.017 may include a
provision for appointment of a member of the board of trustees of a
participating governing body as a member of the board of trustees of the pooled
trust.

4. The term of a member of a board of
trustees appointed pursuant to this section must be at least 2 years, but not
more than 4 years.

5. The governing body may reappoint a member
of the board of trustees, and may alter the composition of the board of trustees
determined pursuant to subsection 1 if required pursuant to NAC 287.790.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. The members of a board of trustees shall
select a chair and vice chair from the members of the board of trustees.

2. The chair of the board of trustees shall:

(a) Preside at all meetings of the board of
trustees; and

(b) Perform the duties incident to the office and
such other duties as may be prescribed by the board of trustees from time to
time.

3. The vice chair shall:

(a) Perform such duties as from time to time may be
assigned to him or her by the chair or by the board of trustees; and

(b) In the absence of the chair, or in the event of
the chair’s inability or refusal to act, as determined by the majority of the
board of trustees, perform the duties of the chair.

4. The board of trustees shall meet
quarterly or at the call of the chair when business is presented. The governing
body may remove a member of the board of trustees if the member fails to attend
two consecutive meetings or any three meetings during a calendar year.

5. The board of trustees shall comply with
the provisions of chapter 241 of NRS.

6. A majority of the members of the board of
trustees constitutes a quorum for all purposes.

7. Any member of the board of trustees may
request a roll call vote of record.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. The board of trustees may not negotiate
or otherwise determine the retirement benefits provided to the beneficiaries of
the trust fund.

2. A member of the board of trustees may not
bind the board of trustees by word or action unless the board of trustees has,
in its corporate capacity, designated such member as its agent for a specific
purpose and for that purpose only.

3. The earnings of the trust fund shall not
inure to the benefit of any member of the board of trustees except that a
member of the board of trustees may be a beneficiary of the trust fund through
participation in his or her employer’s benefits plan.

4. A member of the board of trustees shall
not be interested, directly or indirectly, as principal, partner, agent or
otherwise in any contract entered into or expenditure authorized by the board
of trustees, or in the profits or results thereof.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. A governing body may provide for the
payment to members of the board of trustees of:

(a) Compensation of not more than $80 for each day
or portion of a day that the member is actually engaged in the work of the
board of trustees; and

(b) The per diem allowance and travel expenses
normally provided for officers and employees of the local government, if any,
for each day or portion of a day that the member is actually engaged in the
work of the board of trustees.

2. The governing body shall provide to the
board of trustees the staff necessary to assist the board of trustees in
carrying out its powers and duties, including, without limitation, staff to
organize and provide notice of the meetings of the board of trustees, take the
minutes of such meetings, receive and disseminate financial reports of the professional
fund managers of the trust fund, if any, and prepare financial reports and
budgets for the board of trustees.

3. The governing body shall provide for the
necessary and reasonable expenses of the board of trustees, including, without
limitation, the costs of the annual audit required pursuant to NAC 287.786.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. The governing body shall annually inform
the board of trustees of the amount of the contributions that the governing
body expects to make to the trust fund. In determining such a contribution, the
governing body may:

(a) Commission actuarial studies that estimate the
liabilities of the benefits plan of the local government for the ensuing 5
fiscal years; or

(b) Use an alternative method of calculation that
is allowed by generally accepted accounting principles and which is performed
or commissioned by the governing body.

Ê The results
of any such studies or calculations must be completed before March 1 of each
year in order that the amount of the contributions to the trust fund is
determined before completion of the tentative budget of the board of trustees
for submission to the governing body pursuant to subsection 2.

2. The board of trustees shall annually
submit a tentative budget to the governing body for its consideration, approval
and inclusion in the tentative and final budgets of the governing body. The
tentative budget submitted by the board of trustees must incorporate the amount
of contributions determined pursuant to subsection 1. The governing body may
modify the tentative budget of the board of trustees at its discretion.

3. The board of trustees shall cause the
trust fund to be audited annually. The books, records and accounts of the trust
fund may be audited by the same person or entity that audits the books, records
and accounts of the local government. The governing body shall incorporate the
results of the audit into the annual audit report of the local government.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

2. Unless all the assets of the trust fund
will only be deposited in the Retirement Benefits Investment Fund pursuant to
subparagraph (1) of paragraph (g) of subsection 2 of NRS 287.017, the board of trustees
shall develop an investment plan for the trust fund in consultation with a
professional fund manager, if the board has entered into a contract with such a
person pursuant to subsection 1, or with any other investment management
advisor retained by the board of trustees. The investment plan must be approved
as to its conformity with this subsection by the Committee on Local Government
Finance before the investment of any assets of the trust fund. The investment
plan must:

(a) Include formal investment policies consistent
with the requirements of NRS 287.017
and NAC 287.760 to 287.792,
inclusive, including, without limitation, policies governing acceptable risks,
diversification requirements and the fundamental processes for regulating the
investment of the assets of the trust fund.

(b) Include processes governing the selection and
monitoring of the staff and any professional fund manager or other investment
management advisor assisting the board of trustees in the administration of the
trust fund that are sufficient to ensure such staff, professional fund managers
and other advisors have appropriate expertise and exhibit appropriate fiduciary
behavior for such positions.

(c) Include appropriate investment training for
members of the board of trustees and staff to ensure that they are
knowledgeable in the prevailing investment practices.

(d) Include travel policies for participation in
investment training for members of the board of trustees and staff that support
the need for training and are defensible in the context of the interests of the
public and the beneficiaries of the trust fund.

(e) Include an organizational plan for the
selection and retention of competent investment expertise among the staff and
in professional fund managers and other advisors, and incorporate a competitive
process for the selection of both staff and professional fund managers and
advisors.

(f) Provide for the development of and annual
review by the board of trustees of the asset allocation strategy of the
investment plan and the positioning of classes of assets in the investment
portfolio of the trust fund in light of general market trends and valuations.

(g) Provide, on at least an annual basis, for a
formal evaluation of the role or potential role of passive or indexed
investment strategies applicable to the investment portfolio of the trust fund,
and of appropriate strategies to minimize the costs of the administration of
the trust fund, including, without limitation, the costs of transactions,
professional fund managers and other advisors and investment training.

(h) Provide for a periodic review of
investment-related practices, including, without limitation, services provided
by brokers and unconventional investment strategies, in the context of
fiduciary standards and the interests of economy.

(i) Establish formal benchmarks for the performance
of the portfolio and managed accounts that are specific to the assigned role of
the manager of the portfolio or account.

(j) Provide for the regular evaluation of the
performance of the portfolio using consistent, documented and reliable
disciplines, and establish clear criteria and procedures for selection and
termination of investments by managers.

(k) Provide for regular communications on
investment results to the governing body in a clear and intelligible format.

3. Approval by the Committee on Local
Government Finance of the investment plan required in subsection 2 does not
create or establish any fiduciary responsibility between the Committee on Local
Government Finance and the trust fund or its beneficiaries.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. Except as otherwise provided in
subsection 4, if the market value of the investment portfolio of a trust fund
at the end of a fiscal year is $100,000,000 or less, the assets of the trust
fund may only be:

(a) Deposited in the Retirement Benefits Investment
Fund pursuant to subparagraph (1) of paragraph (g) of subsection 2 of NRS 287.017; and

(b) Invested in any investment which is authorized
for a local government pursuant to subparagraph (2) of paragraph (g) of
subsection 2 of NRS 287.017.

2. Except as otherwise provided in
subsection 4, if the market value of the investment portfolio in a trust fund
at the end of a fiscal year is more than $100,000,000, the assets of the trust
fund may be:

(b) Invested in any investment which is authorized
for a local government pursuant to subparagraph (2) of paragraph (g) of
subsection 2 of NRS 287.017; and

(c) Invested in any stocks or other equity
securities or bonds or other debt securities which meet the requirements of
subparagraph (3) of paragraph (g) of subsection 2 of NRS 287.017.

3. If the market value of the investment
portfolio of a trust fund that is invested pursuant to subsection 2 falls below
$100,000,000 at the end of a fiscal year, the board of trustees:

(a) Is not required to liquidate any investments
described in paragraph (c) of subsection 2.

(b) Shall invest the assets of the trust fund in
the manner set forth in subsection 1 until the market value of the portfolio is
more than $100,000,000.

4. The assets of a pooled trust authorized
pursuant to paragraph (h) of subsection 2 of NRS 287.017 may only be deposited
in the Retirement Benefits Investment Fund established pursuant to NRS 355.220.

5. All interest, earnings, dividends and
distributions received from the investment of assets in the trust fund, minus
the expenses charged for such investments, must be deposited into the trust
fund.

6. Except as otherwise provided in paragraph
(h) of subsection 2 of NRS 287.017,
the trust fund must be maintained as a separate account, and no other money may
be commingled with the money in the trust fund.

7. Money in the trust fund must not be used
to finance the debt of the local government and must not be used for loans to
other funds of the local government.

8. Reasonable charges may be assessed to the
trust fund for reimbursement of the direct expenses incurred by the board of
trustees in administering the trust fund.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)

1. Except as otherwise provided in
subsection 2, the board of trustees shall, upon request of the governing body,
transfer money from the trust fund to an account designated by the governing
body not later than 10 business days after the first day of the month following
receipt of the request by the board of trustees. A request by the governing
body pursuant to this subsection must include, without limitation:

(a) An explanation of the manner in which the
proposed transfer will be used to fulfill the requirements of the benefits plan
of the local government;

(b) A copy of the budget of the local government
for the current fiscal year, which demonstrates that expenditures for
retirement benefits are authorized by the governing body pursuant to an
agreement between the local government and its employees;

(c) Minutes of the meeting of the governing body at
which the transfer was proposed; and

(d) The signature of the chairperson of the
governing body.

2. If the request by the governing body does
not meet the requirements of this section, the board of trustees may delay
transfer of the money until the governing body has complied with the
requirements.

(Added to NAC by Com. on Local Gov’t Finance by R089-08,
eff. 9-18-2008)